Provider Demographics
NPI:1588814487
Name:TULLOS, THOMAS J (MA, LPC, CSAT)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:J
Last Name:TULLOS
Suffix:
Gender:M
Credentials:MA, LPC, CSAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361 TOWNE CENTER PL
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-4869
Mailing Address - Country:US
Mailing Address - Phone:601-977-9353
Mailing Address - Fax:601-977-9422
Practice Address - Street 1:361 TOWNE CENTER PL
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-4869
Practice Address - Country:US
Practice Address - Phone:601-977-9353
Practice Address - Fax:601-977-9422
Is Sole Proprietor?:No
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1193101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health